The CMG Voice

In a recent blog post, we discussed the ways in which virtual reality (VR) and other electronic devices are being used to help treat patients with various medical problems. Not mentioned in that blog was that several studies have investigated the use of a Nintendo Wii balance board for treating brain-injured patients.

In a new study, VR is now being used to diagnose head injuries. Researchers at the University of Birmingham and the University of East Anglia in England conducted trials to evaluate the use of a VR headset to detect subtle neurological changes that can help assess concussions.

Certainly there is a current emphasis on head injuries in football in the U.S that is comparable to the emphasis in Europe on head injuries in soccer. Collision at the goal and “heading” a soccer ball have been known to cause head injuries. In the study, players wore the headset while standing on a balance board and following directions. The inability to comply with some directions helped detect subtle neurological problems.

This particular study was hampered because of the need to connect the VR device to a computer terminal. It is thought that future research may use a mobile VR headset, such as Google Cardboard or Samsung Gear VR.

The use of immersive VR for concussion diagnosis remains an area that has only had limited research to date. But it is likely that, as preliminary results are reported, more researchers will focus on it. The interaction between medicine and electronics is developing rapidly, and it is likely that many new studies will focus on both the diagnostic and treatment potentials of electronic devices.

We all know that wireless is the wave of the electronic future. Wires are becoming things of the past in electronics and fewer people are tripping over them. New research is even finding ways to use wireless technology in the medicine of heart pacemakers.

A group of researchers at Mount Sinai School of Medicine in New York City have conducted a study of using wireless technology in left ventricular pacing systems. In the study, acoustic energy was transmitted from a pulse generator (implanted under the skin over the rib cage) to a left ventricular endocardial pacing electrode. The acoustic energy was transduced to electrical energy.

The experiment was used in patients who did not respond to conventional CRT (implanted cardiac resynchronization therapy), in which an implant resynchronizes the contractions of the heart’s ventricles by sending tiny electrical impulses to the heart muscle, which can help the heart pump blood throughout the body more efficiently. By placing the left ventricular pacing site away from scar tissue it can function more effectively.

This technique is still in the very early stages, and there were numerous technical glitches that need to be dealt with, including concerns about battery life because acoustic energy is being transduced to electrical energy. The study authors stated that “once technical issues have been solved with these systems, randomized clinical trials will be necessary to definitely determine whether leadless systems will be superior to conventional pacemakers.”

As the rapid pace of change in computers and electronics continues, there is no doubt that wireless electronics will receive more attention from physicians and scientists who are looking for new ways to treat common medical conditions.

Two years ago, we authored a blog post about loss of a chance in lung cancer cases, emphasizing non-small cell lung cancer (which comprise about 75% of all lung cancers). The blog post included the following:

“About 85 to 90% of lung cancers are known as ’non-small cell lung cancer,’ a name which covers several subtypes of lung cancer that are grouped together because of similarities in the approach to treatment and outlook. Patients with stage 3b non-small cell lung cancer are typically not offered surgery and treated only with chemo-radiation therapy. These patients have a five-year survival rate of only about 10%. A new study, however, indicates that certain patients with lung cancer that has spread throughout the chest could live longer by undergoing surgery to remove diseased lung tissue instead of only receiving radiation therapy.”

New research and studies, however, are developing targeted therapies (sometimes called precision medicine) that hold the promise of transforming lung cancer into a chronic disease by substantially increasing long-term survival rates. Dr. Edward Kim of the Carolinas HealthCare System Levine Cancer Institute in Charlotte, N.C., has described how testing for certain markers in a patient’s tumor can lead to using a “matching” drug that has fewer side-effects and much greater efficacy.

An example is the “tyrosine kinase inhibitor,” which is used for tumors that have a specific mutation called the “epidural growth factor receptor mutation.” Patients with this particular kind of tumor can simply take a pill as opposed to undergoing systemic chemotherapy. Many of these targeted therapies work even when the lung cancer has metastasized to other organs or parts or the body.

There is another class of drugs, called ALK, which was recently approved by the FDA for lung cancer tumors that have a specific characteristic called “PD-LI”. Dr. Kim said that almost 50% of his center’s lung cancer patients have tumor biomarkers that can be matched to particular drugs that will increase their chance of a cure or of a longer life-expectancy. He stated: “It’s really important to assess not only where the disease is, but what are the markers that are unique to each individual’s tumor.”

From the viewpoint of attorneys representing lung cancer patients, the provable damages from a late-diagnosed lung tumor may be greatly increased because more effective treatments are now available. Only a few years ago, most attorneys declined such cases because, once there were symptoms, the chances of successful treatment were very small.

It is common in my practice to hear stories from potential clients about how their memory of a conversation with a doctor, or of the medical care in particular, is very different than what is written in the medical chart. It is difficult, absent extenuating circumstances, to take case that is built on a jury finding that the patient’s version is true, versus the medical record. I’ve tried and lost such a case.

Still, I will admit my bias, likely caused in part by all of the injured patients I speak with: in the context of litigation I get the feeling doctors do “misremember” things in a way that may not be overtly lying, but may not be entirely truthful. It is also likely true that patients who have been hurt and want to be compensated probably do the same thing.

Apparently, colleagues of defendant doctors do similar things to support their own. Recently an article came out highlighting a recent poll about doctors, nurses and lying. The poll, through Medscape, found that as many of 43% of doctors felt like lying to protect a colleague would be ok in certain circumstances. Only 18% of nurses, on the other hand, felt that way.

With respect to doctors, 38% felt like lying to protect a fellow doctor would be ok so long as the patient wasn’t harmed, while 5% said lying could be justified even if sometimes it was not in the best interest of the patient.

It was unclear from the poll what “not in the best interest of the patient” meant. Certainly in active litigation, “not in the best interest of the patient” means testifying in such a way as to defend fellow health care providers. Again, this may not be overt lying, but it may involve selective memory.

Another question in the poll asked whether the respondent had ever lied to protect a colleague. Almost one fourth of doctors (24%) said they had, while 14% of nurses said they had.

An unidentified doctor was quoted in the article as saying that lying was “medicine’s dirty little secret.” I don’t know about that; I’m not a health care provider. But the numbers in this poll are eye-opening.

You can read the Medscape article detailing the results of this poll here:

It was bound to happen. Technology and the computer age have already infiltrated our health care system in many ways, but a new one may be the use of virtual reality. Cedar-Sinai Medical Center in Los Angeles issued a study (a randomized controlled trial) on inpatient virtual reality use. The trials were in three areas: eating disorders, rehabilitation (motor and cognitive), and pain management.

In general, the trials showed clinical efficacy, although the small sizes of the samples made it difficult to reach far-reaching conclusions. Inpatient pain management was the most successful. As one report asked, “have you ever lain down on a hospital bed counting the days until you are released?” The report described how the team at Cedars-Sinai “introduced VR worlds to their patients to help them release stress and reduce pain.” Using the special goggles, they could ignore the four walls of the hospital and the impact of hospital routine while visiting amazing landscapes in Iceland, participating in the work of an art studio, or swimming together with whales in the deep blue ocean.

Other studies have investigated the use of virtual reality with traumatic brain injury patients, and another looked at stroke rehab with virtual reality. The “brain-body” connection has new meaning when your virtual reality brain can take you to far-away places.

The use of this device can have major impact on children in hospitals. “The experience in a hospital is even more stressful and mentally burdening for small children who miss their parents, their best buddies, their favorite blanket and generally, the soothing environment called home.”

But a Dutch study has found that a smart-phone and virtual glasses can make live contact possible with a 360 degree camera at the patient’s home, school or special occasions such as a birthday celebration or a football game. Though hospitalized, young patients can relax and still enjoy their lives.

Looking forward to your next stay in a hospital? Stay tuned as technology keeps developing new ways to change your ordinary reality, however depressing, to a more interesting one.